Provider Demographics
NPI:1780030452
Name:JONKER, MARK RILEY (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RILEY
Last Name:JONKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:DEPT OF MEDICINE, ROOM L2104
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1235
Mailing Address - Country:US
Mailing Address - Phone:860-679-2437
Mailing Address - Fax:
Practice Address - Street 1:79 RETREAT AVENUE
Practice Address - Street 2:HARTFORD HOSPITAL, ADULT PRIMARY CARE- BROWN STONE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-972-0200
Practice Address - Fax:860-545-3149
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2020-06-03
Deactivation Date:2017-01-20
Deactivation Code:
Reactivation Date:2017-02-22
Provider Licenses
StateLicense IDTaxonomies
CT64205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine